MEDICARE: CHAUNCEY L MURDOCK LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	209265	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285822528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAUNCEY L MURDOCK LVN

Provider Business Mailing Address
First Line	:	1101 FLORIDA ST
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-2907
Country	:	US
Telephone Number	:	619-423-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 FLORIDA ST
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-2907
Country	:	US
Telephone Number	:	619-423-3295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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